DEMO-15-1541 Miami Shores Village F j,i: ": �WfI-N
Building Department JUN 2015
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax: (305)756-8972yx
INSPECTION LINE PHONE NUMBER:(305)762-4949
IFBCC 20 k(3
BUILDING Master Permit No.
PERMIT APPLICATION Sub Permit No.
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 548 Grand Concourse
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-3206-017-1410 Is the Building Historically Designated:Yes X NO
Occupancy Type: SFR Load: Construction Type: Flood Zone: 8FE: FFE:
OWNER: Name(Fee Simple Titleholder):ASHLEY M ApjL f 'tea , Phone#:9176570713
Address:548 Grand Concourse
City: Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email matthewvanderwerff@gmaii.com
CONTRACTOR:Company Name: OWNER/ BUILDER Phone#:
Address:
City: State: Zip:
Qualifier Name: Phone#:
State Certification or Registration#: Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address: ~7 City`. State-Zip:
Value of Work for this Permit:$ Square/Linear Footage of Work: C._
Type of Work: ❑ Addition ❑ Alteration ❑ NewK,�1 �++❑'' Repair/Replace �em�Ition
Description of Work: � � Y% �l- l �N (E�'1
Cj
Specify color of color thru tile:
Submittal Fee$ S O 'co Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
Bonding Company's Name(if applicable)_
Bonding Company's Address _
City _State_ Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: 1 certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also,a certified copy of the're.rorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the bu`kin ,is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged." s % t
't
Signatu '` - Signature
�NERECT CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
day of 220 15 , by day of 20 ,by
` lily 1 11,41y known to who is personally known to
me or who has roduced _
�n •. as me or who has produced as
identification and who did to t� identification and who did take an oath.
:cs 0 �o-
NOTARY PUBLIC: - �yo /r•�xZ� ' �Lt-= NOTARY PUBLIC:
Sign: o����iprMR IA.®,...\� ���� Sign:
1/Iilllf INI0
Print: Print:
Seal: Seal-:
APPROVED BY Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)